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"ABSTRAKKeefektifan obat oral Inflammatory Bowel Disease IBD dipengaruhi oleh sifat farmakokinetik yang meliputi porses absorpsi, distribursi, metabolisme, dan ekskresi ADME. Sifat yang akan dibahas pada penelitian ini adalah sifat farmakokinetik yaitu tentang absorpsi obat dalam tubuh. Tujuan dari penelitian ini adalah mengetahui parameter farmakokinetik yang dapat diprediksi oleh peranti lunak yang digunakan, menemukan peranti lunak yang paling baik dalam memprediksi parameter farmakokinetik obat, dan mencari korelasi antara parameter farmakokinetik yang digunakan sebagai deskriptor dengan persen absorpsi referensi. Manfaat dari penelitian ini adalah perolehan hasil analisis prediksi parameter farmakokinetik obat oral IBD berdasarkan parameter absorpsi dapat dijadikan dasar pertimbangan untuk melakukan pengembangan obat oral IBD. Penelitian ini menggunakan peranti lunak Molinspiration, QikProp, admetSAR, SwissADME, Chemicalize, pkCSM, dan Microsoft Excel. Penelitian ini menggunakan 34 senyawa obat IBD dan 8 deskriptor yang terdiri dari deskriptor dependen persen absorpsi ABS serta deskriptor independen bobot molekul BM, logP, hydrogen bond acceptor HBA, hydrogen bond donor HBD, polar surface area PSA, pKa dan Caco2 permeability yang didapatkan dari penelitian Zhao et al. 2002 dan penelitian pendahulu. BM, logP, HBA, HBD dan PSA dapat diprediksi oleh peranti lunak QikProp, SwissADME, Molinspiration, dan Chemicalize. pKa dapat diprediksi menggunakan Chemicalize. Caco2 permeability dapat diprediksi oleh peranti lunak QikProp, admetSAR, dan pkCSM. SwissADME paling akurat dalam memprediksi BM, logP, dan HBD. Chemicalize paling akurat dalam memprediksi HBA, PSA, dan pKa. admetSAR paling akurat dalam memprediksi Caco2 permeability. Nilai R paling tinggi didapat dari korelasi ABS dengan Caco2 permeability prediksi pada 34 senyawa obat dengan nilai R = 0,8211.

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ABSTRACTInflammatory Bowel Disease IBD is a chronic, idiopathic, and inflammatory bowel condition Brunton, Chabner, Knollmann, 2011 . The effectiveness of IBD drugs is affected by pharmacokinetic properties that involves absorption, distribution, metabolism, and excretion ADME. This research analyzed the absorption of drugs in the body. The purpose of this research is to know the pharmacokinetic parameters that can be predicted by the software used, to discover the best software in order to predict pharmacokinetic properties, and to analyze the correlation between pharmacokinetic parameters used as descriptor with absorption percentage from reference. The result of this research can be considered to develop IBD oral drugs. This research uses Molinspiration, QikProp, admetSAR, SwissADME, Chemicalize, pkCSM, and Microsoft Excel. This research used 34 compounds of IBD oral drugs and 7 descriptors consist of dependent descriptor absorption rate ABS and independent descriptors molecular weight MW, logP, hydrogen bond acceptor HBA, hydrogen bonding donor HBD, polar surface area PSA, pKa, and Caco2 permeability discovered from research Zhao et al. 2002a and previous research. MW, logP, HBA, HBD and PSA can be predicted by QikProp, SwissADME, Molinspiration, and Chemicalize. pKa can be predicted using chemicalize. Caco2 permeability can be predicted by QikProp, admetSAR, and pkCSM. SwissADME is the most accurate software in predicting MW, logP, and HBD. Chemicalize is the most accurate software in predicting HBA, PSA, and pKa. admetSAR is the most accurate software in predicting Caco2 permeability. The highest R value was obtained from the correlation between ABS with Caco2 permeability on 34 drug compounds R 0.8211. "

"The term "Inflammatory Bowel Disease" (IBD) is frequently used to denote two diseases, ulcerative colitis (UC) and Crohn's disease (CD). This condition is frequently recorded in the West, and along with development of diagnostic facilities, is beginning to be more commonly found in Indonesia.The etiology of this disease is still unclear, but it is suspected that environmental, geographic, and genetic factors are involved. Cytokines play a great role in the pathogenesis of IBD, where in IBD there is an unbalance of pro-inflammatory cytokines and inhibitor cytokines. In IBD, there is an increase in pro-inflammatory cytokines, such as IL-1, IL-2, IL-6, IL-8, and alpha TNF in the intestinal mucosa. Such increase significantly correlates with the activity of ulcerative colitis through endoscopic examination,At this moment, forms of therapy for IBD associated with cytokines are being developed, such as ways to inhibit cytokine synthesis, cytokine release, cytokine activity and the cytokine signaling pathway in the target cell."

"ABSTRAKInflammatory Bowel Disease (IBD) adalah penyakit yang semakin meningkatprevalensinya selama dua dekade terakhir. Baku emas diagnosis IBD adalah kolonoskopidan histopatologi. Calprotectin feses merupakan salah satu pemeriksaan yang banyakdiminta untuk menapis pasien terduga IBD agar mengurangi kolonoskopi yang tidakperlu. Metode pemeriksaan calprotectin yang banyak digunakan sekarang adalah ELISA,tetapi saat ini terdapat metode baru yaitu CLIA. Penelitian ini bertujuan membandingkancalprotectin feses antara kedua metode tersebut, melakukan uji diagnostik denganperbandingan baku emas, dan membandingkan calprotectin pada kelompok IBD dan non-IBD. Penelitian dilakukan secara potong lintang dan data disajikan secara deskriptifanalitik dengan melibatkan 50 pasien dewasa. Uji korelasi antara kedua metodemenemukan hubungan kuat dan bermakna (r=0,865, p<0,001), tetapi persamaan regresiPassing-Bablok mendapatkan perbedaan konstan dan proporsional. Uji Bland-Altmanmendapatkan kesesuaian 92% dengan rerata selisih 76,2 μg/g feses dan batas kesesuaian-964,3-1116,7 μg/g feses. Uji diagnostik calprotectin feses metode ELISA menemukantitik potong optimal adalah 194 μg/g dengan sensitivitas 55,6%, spesifisitas 56,5%, NPP60%, dan NPN 48%. Apabila menggunakan titik potong pabrik 50 μg/g, maka didapatkansensitivitas 88,9%, spesifisitas 13%, NPP 54,5%, dan NPN 50%. Uji diagnostikcalprotectin feses metode CLIA menemukan titik potong optimal adalah 90,5 μg/gdengan sensitivitas 51,9%, spesifisitas 52,2%, NPP 56%, dan NPN 48%. Apabilamenggunakan titik potong pabrik yaitu 50 μg/g, maka diperoleh sensitivitas 70,4%,spesifisitas 43,5%, NPP 59,4%, dan NPN 55,6%. Perbandingan calprotectin feses metodeELISA antara kelompok IBD dan non-IBD menemukan perbedaan rerata yang tidakbermakna secara statistik, begitu juga dengan perbandingan kelompok IBD dan non-IBDpada calprotectin feses metode CLIA. Penelitian ini menemukan bahwa kedua kitpemeriksaan tidak dapat saling menggantikan dan uji diagnostik menemukan akurasidiagnostik yang buruk. Penelitian selanjutnya harus mengeksklusi kolitis infektif untukmempertajam diagnosis terduga IBD dan menemukan pasien IBS dengan melibatkanrumah sakit lain.

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ABSTRACTInflammatory Bowel Disease (IBD) prevalence has been increasing since last twodecades. Gold standard to diagnose IBD is colonoscopy and histopathology. Fecalcalprotectin is frequently ordered test for screening of patient with suspect IBD sounnecessary colonoscopy can be reduced. Method often used today is ELISA, but CLIAmethod is available nowadays. This study was aimed to compare fecal calprotectin testbetween this two method, to perform diagnostic test with gold standard, and compare thelevel of fecal calpoctin between IBD and non-IBD group. Study design was crosssectional and was presented as descriptive-analytic data, involving 50 subjects.Correlation between two method is strong and statistically significant (r=0,865, p<0,001),but Passing-Bablok regression test found constant and proportional difference. Bland-Altman test found agreement was 92% with mean difference 76,2 μg/g faeces and borderof agreement -964,3-1116,7 μg/g faeces. Diagnostic test with ELISA method foundoptimal cut-off was 194 μg/g with sensitivity 55,6%, specificity 56,5%, PPV 60%, andNPV 48%. If cut-off from manufacturer was used (50 μg/g), sensitivity 88,9%, specificity13%, PPV 54,5%, and NPV 50%. Diagnostic test with CLIA method found optimal cutoffwas 90,5 μg/g with sensitivity 51,9%, specificity 52,2%, PPV 56%, and NPV 48%. Ifcut-off from manufacturer was used (50 μg/g), sensitivity 70,4%, specificity 43,5%, PPV59,4%, and NPV 55,6% . Difference level of fecal calprotectin between IBD and non-IBD group is not statistically significant, both with ELISA and CLIA method. This studyfound that these two fecal calprotectin is not interchangeable and diagnostic test foundpoor result. Future study should give more restriction to diagnose suspect IBD byexclusion of infective colitis and found IBS cases by involving other hospital."

"Inflammatory bowel disease (IBD) in rarely found in clinical practice. However, the incidence of IBD seems to have increased recently. Generally, the patients will come to hospital with chief complain! of chronic diarrhea with or without hematochezia.We reported two cases of IBD in which they had been misdiagnosed as colitis tuberculosis based on colonoscopy examination. Treatment of anti tuberculosis drugs had made no clinical improvement. Further evaluation suggested the diagnosis of IBD. They responded very well clinically after treated as IBD. This case report reminds us to consider the diagnosis of IBD in patient with chronic diarrhea and ulceration in colonic mucosa at colonoscopy."

"Inflammatory bowel disease (IBD) has begun to emerge in Indonesia. The disease is further classified into two types, ulcerative colitic (UC) and crohn's disease (CD). Diagnosis of IBD is initiated from symptom findings such as diarrhea, abdominal pain, bleeding diarrhea, and weight loss, and supported by physical examination and additional tests. The options for additional examinations of IBD are mainly endoscopy (esophagogastroduodenoscopy, colonoscopy, and also intestinal endoscopy), imaging the techniques and laboratory examinations either from blood or feces. The application of these modalities should be prompted by sufficient clinical suspicion to promote their efficiency as well as prevent underdiagnosis or overdiagnosis. In primary health care settings, patients with IBD are expected to be recognized for therapy or to use appropriate referral system to warrant a proper treatment."

"Inflammatory bowel disease (IBD) merupakan penyakit kronis saluran cerna dengan siklus eksaserbasi-remisi. Masih terdapat tantangan dalam mempertahankan remisi dan menunda flare pada pasien IBD. Asupan gizi tertentu dapat memodifikasi mediator inflamasi pada saluran gastrointestinal sementara aktivitas fisik dapat mempengaruhi kadar sitokin sehingga keduanya dapat mempengaruhi perjalanan IBD. Penelitian ini bertujuan untuk menganalisis hubungan antara potensi inflamasi diet dan aktivitas fisik dengan aktivitas penyakit IBD.Metode: Penelitian ini menggunakan desain potong lintang pada pasien IBD yang melakukan kontrol di Poliklinik Gastroenterologi Rumah Sakit Cipto Mangunkusumo (RSCM) selama periode Juli–September 2022. Pengambilan data mengenai potensi inflamasi diet berdasarkan skor Dietary Inflammatory Index (DII) dan aktivitas fisik berdasarkan skor International Physical Activity Questionnaire (IPAQ). Derajat aktivitas penyakit IBD diperoleh berdasarkan kuesioner Indeks Harvey-Bradshaw (HBI) untuk Penyakit Crohn (PC) dan Simple Colitis Clinical Activity Index (SCCAI) untuk Kolitis Ulseratif (KU). Analisis statistik dengan menggunakan uji KruskalWallis, Spearman, dan Regresi linear multipel.Hasil: Sebanyak 100 subjek penelitian didapatkan rerata skor DII pada kelompok PC adalah 0,22± 2,20 dengan tren rerata yang meningkat signifikan seiring dengan keparahan PC: -0,13 ± 2,3 (remisi), 0,17 ± 2,51 (ringan), 0,65 ± 2,11 (sedang), 0,68 ± 1,60 (berat); p=0,02. Rerata skor DII pada kelompok KU adalah 0,11 ± 2,45 dan tidak ditemukan perbedaan bermakna antar subgrup keparahan. Rerata skor aktivitas fisik pada kelompok PC dan KU berturut-turut adalah 5097,4 ± 2955,7 dan 6023,7 ± 4869,4. Tidak ditemukan perbedaan bermakna antara tingkat aktivitas fisik dan derajat aktivitas penyakit IBD. Skor DII secara independen dapat mempengaruhi aktivitas penyakit PC dari analisis multivariat (koefisien Î² 0,370; p= 0,006). Kesimpulan: Terdapat hubungan signifikan antara potensi inflamasi diet dengan derajat aktivitas penyakit PC. Tidak terdapat hubungan antara potensi inflamasi diet dengan derajat aktivitas penyakit KU maupun antara aktivitas fisik dengan derajat aktivitas penyakit IBD.

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Background: inflammatory bowel disease (IBD) is a chronic gastrointestinal disease with exacerbation-remission cycles. There are still challenges in maintaining remission and preventing flares in IBD patients. Intake of certain nutrients can modify inflammatory mediators of the gastrointestinal tract while physical activity may affect cytokine levels, therefore both can influence the course of  IBD. This study aims to analyze the association between inflammatory potential of diet and physical activity with IBD disease activity.

Method: in this cross-sectional study, IBD patients who had regular control at the gastroenterology outpatient clinic of RSCM were recruited during the period of July–September 2022. The data of inflammatory potential of diet obtained through the dietary Inflammatory Index (DII) score and physical activity data obtained through the International Physical Activity Questionnaire (IPAQ) score. The degree of IBD disease activity based on the Harvey-Bradshaw Index (HBI) for Crohn’s Disease (CD) and the Simple Colitis Clinical Activity Index (SCCAI) for Ulcerative Colitis (UC). Statistical analysis using the Kruskal-Wallis test, Spearman test, and Multiple Linear Regression test.

Results: A total of 100 subjects obtained the mean DII score in the CD group was 0.22± 2.20 with an upward trend that increased significantly as CD disease severity progressed: -0.13 ± 2.3 (remission), 0.17 ± 2.51 (mild), 0.65 ± 2.11 (moderate), 0.68 ± 1.60 (severe); p=0,02. The mean DII score in the UC group was 0.11 ± 2.45 and there was no significant difference among severity subgroups. The mean physical activity scores in the CD and UC groups were 5097.4± 2955.7 and 6023.7 ± 4869.4 respectively. There was no significant difference of physical activity among various degrees of IBD severity. DII scores independently influenced CD disease activity based on multivariate analysis (β-coefficient 0.370; p= 0.006).

Conclusion: A significant association between the inflammatory potential of diet and CD disease activity was observed. There was no association between inflammatory potential of diet and UC disease activity, as well as between physical activity and IBD disease activity."

"Latar Belakang. Penyakit radang usus atau Inflammatory Bowel Disease (IBD) memiliki gejala gangguan saluran pencernaan yang tidak dapat diprediksi, tidak menyenangkan, dan kerap kali menimbulkan rasa malu bagi penderitanya. Berbagai ketidaknyamanan tersebut dapat mempengaruhi penurunan kualitas hidup pasien IBD hingga meningkatkan morbiditas dan mortalitas di masa depan. Perlu instrumen yang sahih dan andal untuk menilai kualitas hidup pasien dengan IBD.Tujuan. Penelitian ini bertujuan untuk mengetahui keandalan dan kesahihan Inflammatory Bowel Disease Questionnaires-9 (IBDQ-9) versi bahasa Indonesia untuk menilai kualitas hidup pasien dengan IBD.Metode. Instrumen asli IBDQ-9 diterjemahkan ke bahasa Indonesia dan diterjemahkan kembali ke bahasa Inggris lalu dikonfirmasi kepada pemilik instrumen. Kemudian dilakukan uji kesahihan isi dengan Content Validity Index (CVI). Studi potong lintang dengan populasi terjangkau pasien dewasa IBD di Poliklinik Gastroenterologi, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta pada bulan November 2022 yang berusia 18-59 tahun, telah mengalami IBD minimal 2 minggu dan bersedia untuk menandatanganiinformed consent sebagai responden penelitian. Perbandingan skor total IBDQ-9 dengan SF-36 versi Indonesia dinilai dengan uji korelasi Spearman lalu uji keandalan dengan menentukan alfa Cronbach dan Intraclass Correlation Coefficient (ICC).Hasil. Sebanyak 124 pasien IBD dianalisis dengan uji Spearman menunjukkan korelasi yang tinggi dan signifikan antara IBDQ-9 dengan SF-36 (r=0,769 dan p<0,001). IBDQ-9 versi bahasa Indonesia memiliki nilai alfa Cronbach versi bahasa Indonesia sebesar 0,883 dan nilai ICC yang baik juga sebesar 0,883 (IK95% 0,849-0,912).Kesimpulan. Instrumen IBDQ-9 versi Bahasa Indonesia sahih dan andal untuk menilai kualitas hidup pasien dengan IBD di Indonesia.

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Latar Belakang. Penyakit radang usus atau Inflammatory Bowel Disease (IBD) memiliki gejala gangguan saluran pencernaan yang tidak dapat diprediksi, tidak menyenangkan, dan kerap kali menimbulkan rasa malu bagi penderitanya. Berbagai ketidaknyamanan tersebut dapat mempengaruhi penurunan kualitas hidup pasien IBD hingga meningkatkan morbiditas dan mortalitas di masa depan. Perlu instrumen yang sahih dan andal untuk menilai kualitas hidup pasien dengan IBD.

Tujuan. Penelitian ini bertujuan untuk mengetahui keandalan dan kesahihan Inflammatory Bowel Disease Questionnaires-9 (IBDQ-9) versi bahasa Indonesia untuk menilai kualitas hidup pasien dengan IBD.

Metode. Instrumen asli IBDQ-9 diterjemahkan ke bahasa Indonesia dan diterjemahkan kembali ke bahasa Inggris lalu dikonfirmasi kepada pemilik instrumen. Kemudian dilakukan uji kesahihan isi dengan Content Validity Index (CVI). Studi potong lintang dengan populasi terjangkau pasien dewasa IBD di Poliklinik Gastroenterologi, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta pada bulan November 2022 yang berusia 18-59 tahun, telah mengalami IBD minimal 2 minggu dan bersedia untuk menandatangani

informed consent sebagai responden penelitian. Perbandingan skor total IBDQ-9 dengan SF-36 versi Indonesia dinilai dengan uji korelasi Spearman lalu uji keandalan dengan menentukan alfa Cronbach dan Intraclass Correlation Coefficient (ICC).

Hasil. Sebanyak 124 pasien IBD dianalisis dengan uji Spearman menunjukkan korelasi yang tinggi dan signifikan antara IBDQ-9 dengan SF-36 (r=0,769 dan p<0,001). IBDQ-9 versi bahasa Indonesia memiliki nilai alfa Cronbach versi bahasa Indonesia sebesar 0,883 dan nilai ICC yang baik juga sebesar 0,883 (IK95% 0,849-0,912).

Kesimpulan. Instrumen IBDQ-9 versi Bahasa Indonesia sahih dan andal untuk menilai kualitas hidup pasien dengan IBD di Indonesia."

"The pathogenesis of inflammatory bowel disease (IBD) is not yet fully understood A genetic predisposition, some environmental factors and microbial flora of the grit are the key factors. The presence of bacteria in the intestinal lumen is a prerequisite for the development of IBD. In animal models, mice incapable of expressing IL, or IL invariably develop a colitis- or Crohn-like inflammation. No inflammation occurs if they grow up in a pathogen free environment or if they are fed with Lactobacillus sp when exposed to environmental bacteria. Thus, the absence of liminal bacteria or a different make-up there of prevents the development of inflammatory bowel disease in this model. Patients with IBD have been found to have a decreased stool excretion Lactobacillus andlor Bifidobacteria. Furthermore, an increased number of bacteria adherents to the mucosa and within the epithelium has been demonstrated in quantitative studies. It appears that these bacteria trigger a strong abnormal mucosal immunological response, leading to intestinal epithelial cell injury mediated by activated T-cells, mononuclear cells and macrophages. If this response can not be down regulated by regulatory T-cells, mononuclear inflammatory cytokines are activated by stimulation of the intracellular transcription factor NF-kB. Recently it was shown that bacterial lipopolysaccharides can activate NF-kB by binding to two specific receptors on the cell membrane (Toll-like receptors [TLR's]) or intracellular receptors (NOD's). New insights of the role of bacteria in IBD became available by identifying susceptibility genes for IBD. Several IBD susceptibility loci were recently identified. The IBD-l locus on chromosome 16 shows positive evidence for linkage in Crohn's disease and IBD-2 locus on chromosome l2 for ulcerative colitis. The evidence for' an association with Crohn's disease at the IBD-I locus have been shown to be attributed to mutations in the CARDI5/NOD2 gene. This gene is exressed in peripheral blood monocytes and in intestinal epithelial cells and serves as a key factor of innate mucosal response to luminal bacteria as an antibacterial factor. The intact intercellular NOD2 protein binds LPS and activates NF-kB. This activation of the NF-kB signalling pathway in response to bacterial components plays a protective role in the mucosal epithelial cells for the host against inviting pathogens and an increased apoptosis of infected cells. There is evidence, that the defective NOD2 protein variants increase the susceptibility to pathogen invasion and a decrease in cellular apoptosis. NF-kB plays a dual role in IBD. On the mucosal epithelial cells, bacterial components bind on NOD2 proteins and protect bacterial invasion. If this barrier mechanism is not intact, the bacterial invasion stimulates via TLR- and NOD2 receptors in immune-active cells (macrophages, T-cells and monocytes) NF-kB and triggers an aberrant inflammatory response leading to tissue damage. These new insights in the pathogenesis in IBD have led to new treatment possibilities including pre- and probiotics. These therapies are aimed at directly modulating the host immune system to suppress intestinal inflammation. This has prompted considerable interest in manipulating the enteric microenvironment as a novel therapeutic strategy Several clinical studies showed promising results rising pre- and probiotics in patients with ulcerative colitis, pouchitis and Crohn's disease. The introduction of genetically engineered probiotic organism to produce and deliver anti-inflammatory cytokines or other biological relevant molecules to the mucosa offers further new potential for the treatment of IBD."